Shoulder Pain & Adhesive Capsulitis

Adhesive capsulitis, commonly called frozen shoulder, is more than just stiffness—it’s a painful condition that limits shoulder movement and disrupts daily life. Let’s take a deep dive into this condition, explore its causes, symptoms, and contributing factors, and uncover how targeted therapies can help—especially by addressing a key muscle you might not even know about: the subscapularis.

_______________________________________________________________________________________________________

What Is Frozen Shoulder, and Who Does It Affect?

Frozen shoulder develops when the joint capsule surrounding the shoulder becomes thickened and inflamed, leading to stiffness, pain, and restricted movement. The condition typically unfolds in three stages:

1. Freezing Phase: Increasing pain and decreasing mobility.
2. Frozen Phase: Persistent stiffness and pain reduction.
3. Thawing Phase: Gradual improvement in motion.

This condition most often affects adults between 40 and 60 years old, earning it the nickname “40-year-old shoulder.” Women are particularly prone, especially those with underlying conditions like diabetes, hypothyroidism, or cardiovascular issues. Frozen shoulder can also develop after shoulder surgeries, injuries, or prolonged immobilization.

_______________________________________________________________________________________________________

Key Players in Frozen Shoulder

Frozen shoulder involves multiple components of the shoulder complex:

• Joint Capsule: Thickening and fibrosis restrict normal shoulder movement.
• Rotator Cuff Muscles: Tightness or dysfunction in these muscles exacerbates the condition.
• Subscapularis Muscle: This often-overlooked muscle is a major contributor.

Why the Subscapularis Matters

The subscapularis, located on the underside of the shoulder blade, is responsible for internal rotation and stabilizing the shoulder. Tightness or trigger points in this muscle can limit range of motion, increase pain, and create a vicious cycle that perpetuates frozen shoulder. Research supports this connection, showing a strong correlation between subscapularis dysfunction and adhesive capsulitis (PubMed Study).

______________________________________________________________________________________________________

How Chiropractic Care Can Help

Effective treatment for frozen shoulder goes beyond addressing the shoulder itself—it involves the adjacent structures that influence its function, like the thoracic spine and rib cage. A study published in the Journal of Chiropractic Medicine demonstrates how chiropractic adjustments improve shoulder mobility by addressing restrictions in the upper back and neck (Source).

Mobilizing the Thoracic Spine

• Enhances scapular mechanics, improving shoulder movement.
• Reduces referred pain from the neck and upper back.
• Restores proper posture, relieving strain on the shoulder.

______________________________________________________________________________________________________

Therapies That Work

Frozen shoulder responds well to a combination of interventions:

• Trigger Point Dry Needling (TrP-DN): Targets trigger points in the subscapularis and other muscles to reduce pain and increase range of motion.
• Manual Therapy: Techniques like myofascial release and joint mobilization relieve stiffness in the capsule and surrounding tissues.
• Chiropractic Adjustments: Focus on thoracic spine and cervical alignment to improve overall biomechanics.

_____________________________________________________________________________________________________

Simple Home Exercises for Frozen Shoulder

Targeted exercises can support recovery by improving subscapularis function and addressing imbalances. Here are three to try:

• Self-Massage/Mobilization 
• How: Use your fingers or a massage ball to apply gentle pressure to the subscapularis (located in the armpit area). Hold tender spots for 20-30 seconds.
• Why: Relieves tension and improves blood flow.
• Doorway Stretch (Flexibility)
• How: Stand in a doorway, placing your forearm on the frame with your elbow bent at 90 degrees. Lean forward gently to stretch the front of your shoulder. Hold for 30 seconds and repeat 2-3 times.
• Why: Loosens tight anterior shoulder muscles and improves subscapularis flexibility.
• External Rotation with Resistance Band (Strengthening)
• How: Attach a resistance band to a stable surface. Hold the band with your affected arm, elbow bent at 90 degrees. Pull the band outward, rotating your shoulder externally. Perform 2-3 sets of 10 repetitions.
• Why: Strengthens external rotators to balance subscapularis activity.

Additional Resource: Dr. Adam Fields has created a must-watch video with fun, effective stretches and dynamic motions to mobilize your shoulder and mid-back. His great personality makes it an enjoyable and approachable way to get moving and reclaim your range of motion. (Video Source)

______________________________________________________________________________________________________

Why a Holistic Approach Works

Adhesive capsulitis is a complex condition that requires a comprehensive approach. Chiropractic care, manual therapy, and dry needling work together to target all contributing factors, from tight muscles like the subscapularis to poor thoracic mobility. Clinical evidence supports the efficacy of these treatments in improving pain and range of motion.

If you’re struggling with frozen shoulder, don’t let it hold you back any longer. At TULA Mobile Chiropractic, we offer a personalized care plan tailored to your specific needs. Combined with practical home exercises, our approach is designed to restore your mobility and help you get back to doing the activities you love. Let us help guide you on the path to recovery and a pain-free lifestyle.